Clinical features

There may be:

• fever
• lymphangitis
• varicosities of the lymphatic vessels
• chylous ascites
• hydrocoeles
• chyluria
• chylous fistulae on the scrotum and groins:
  • scrotal involvement occurs almost exclusively in Bancroftian filariasis
• solid oedema - elephantiasis - most commonly affecting the legs, scrotum and arms, but may occur anywhere
• hyperkeratosis of the extremities

After a 10-12 month incubation period, the patient may present with a fever lasting 3-5 days. There may be lymphangitis with the involved superficial lymphatics appearing as red streaks, which are tender and cord like. The inflammation may improve spontaneously, though it is often recurrent. This inflammatory phase is then followed by lymphatic obstruction, which long-term produces elephantiasis with distal thick rough skin which occasionally ulcerates.

Nocturnal respiratory symptoms such as cough, dyspnoea or wheeze is suggestive of tropical pulmonary eosinophilia.